"Forgotten" Chapters in the History of Transcervical Sterilization: Carl Clauberg and Hans-Joachim Lindemann.

Transcervical sterilization is a non-surgical method of permanent female sterilization that is widely used and critically discussed. A review of the historiography of the method reveals that instances of its coercive use are not included in the historical account. This study offers a reexamination of the work of Carl Clauberg and Hans-Joachim Lindemann, to more deeply contextualize within the framework of current usage the coercive use of transcervical sterilization during the Third Reich and in postwar Germany. This inquiry is based on postwar criminal trial records on Clauberg, and on archival documents detailing Lindemann's activities in 1979. A comparative analysis examines arguments by medical historian Karl-Heinz Roth, and identifies shared characteristics and differences between Clauberg and Lindemann, their methods and scientific connections. The results demonstrate that the technique of transcervical sterilization has an abusive potential that may be explained as a function of the person of the physician, of the scientific method itself, and of societal and political influences. The analysis supports the argument that insights from the cases of Clauberg and Lindemann are transferrable geographically and over time, and have the potential to inform current medical practice, such as transcervical sterilization with the Essure device, whose historiographic exploration remains a desideratum.

Quinacrine sterilization (QS): time for reconsideration.

Dr. Jaime Zipper, the Chilean inventor of the quinacrine method of nonsurgical permanent contraception, was aware that when chest surgeons injected quinacrine into the pleural cavity to treat and prevent reoccurrence of pleural effusion, it resulted in the formation of fibrous adhesions between the lung and costal pleura. Zipper thought that a similar scarring effect could occur in the fallopian tubes if quinacrine was instilled into the uterine cavity. A series of refinements of the methodology culminated in the use of a modified Copper T intrauterine device inserter tube as a delivery system to introduce seven quinacrine pellets into the uterus. This approach with quinacrine sterilization (QS) was introduced into clinical practice in several countries, and a national clinical trial of over 50,000 women was conducted in Vietnam. However, in 1993, the World Health Organization raised concerns that quinacrine might be carcinogenic. This resulted in abandonment of QS in Vietnam and other countries. Subsequent epidemiologic data from extensive human studies do not support an increase in cancer risk. This paper reviews the history, limitations and clinical potential of QS.

A nonsurgical permanent contraception stakeholder advisory committee: FHI 360's experience.

As part of its research program on nonsurgical permanent contraception, FHI 360, a nonprofit human development organization, created a stakeholder advisory committee to help address the controversy surrounding quinacrine. This committee contributed to FHI 360's research agenda, liaised with other stakeholders and provided input on key decisions. This report summarizes the process for establishing the committee, delineates the successes and challenges that arose and specifies recommendations for other organizations considering stakeholder collaboration.

Medicina y nazismo. Aprender de la Historia / Nazism and Medicine. Learning from History

En el momento actual siguen vigentes en la asistencia diaria de los pacientes los mismos aspectos éticos presentes durante ese período (límites de la investigación, decisiones al final de la vida, relación del médico con el estado e investigación genética). Conocer el pasado y el papel desempeñado por los médicos nazis refuerza el necesario énfasis en la bioética y en el profesionalismo dentro de la formación de los profesionales sanitarios. Entre 1933 y 1945, en la Alemania nazi médicos y otros profesionales participaron en la esterilización de pacientes portadores de enfermedades genéticas y mentales, en el asesinato de enfermos mentales y de niños con malformaciones, en experimentos científicos y seudocientíficos que no contaban con la voluntad de los participantes, y en el exterminio de otras personas en función de su condición religiosa, política, cultural o de identidad (opositores, judíos, gitanos y homosexuales, entre otros)(AU)

Between 1933-1945 in Nazi Germany, physicians and other professional care providers participated in forced sterilization of patients who were carriers of genetic origin diseases and psychiatric disorders, extermination of children and adults with congenital and mental diseases, “scientific and pseudoscientific” medical experiments without consent and mass extermination of people based on their religion, political, cultural or sexual identity (Jews, gypsies, homosexuals). At present, the same ethical issues present during Nazi Period (research limits, end-life decisions, role of the physician as state or health system servant, and genetic research) continue to be present in routine medical care. Having knowledge of the past and the role played by Nazi doctors reinforces the necessary emphasis on bioethics and professionalism within the training of professional health providers(AU)

State-of-the-art of non-hormonal methods of contraception: V. Female sterilisation.

OBJECTIVE: Systematic review of the literature on the effectiveness and safety of permanent female contraception. MATERIAL AND METHODS: A systematic Medline and Cochrane Library review of the literature on technique, effectiveness, safety and complications of female sterilisation. Keywords used for research were 'female sterilisation', 'tubal occlusion', 'history', 'counselling', 'hysteroscopy', 'laparoscopy', 'complications' and 'effectiveness'. RESULTS: Worldwide over 220 million couples have resorted to either male (nearly 43 million) or female sterilisation (180 million). In this review the different methods of female sterilisation are described and their advantages and disadvantages discussed. Tubal occlusion is carried out via (mini-) laparotomy, laparoscopy or hysteroscopy. The Ovabloc, Essure and Adiana permanent contraception systems make use of the latter route. CONCLUSIONS: Female sterilisation via the transcervical route is an outpatient or office procedure; it is performed under local anaesthesia or even without anaesthesia. Its complication rate is low. It should be preferred to the abdominal procedures provided the equipment and the experience required are available. Counselling should include information on vasectomy for the partner as well as on alternative long-acting reversible contraceptives. The ten-year cumulative pregnancy rate of sterilisation techniques ranges from 0.1 to 3.6 per 1000 procedures. The life-time risk of failure is around 1/200.

Secuestrando el feminismo global: feministas, la Iglesia católica y la debacle de la planificación familiar en el Perú / Appropriating of the global feminism: feminists, the catholic church and the fall of the familiar planning in Peru

Entre los años 1996 y 1998 el programa de planificación familiar dirigido por el gobierno de Alberto Fujimori organizó campañas masivas de esterelización dirigidas a mujeres de comunidades pobres, indídigenas y rurales. El programa dio prioridad a la esterelización sobre otras formas de contracepción y realizaró las esterelizaciones quiuen las pacientes. Asimismo, muchas veces realizaron las esterelizaciones sin obtener previamente el consentimiento voluntario o informado de las pacientes. El número estimado de estas esterilizaciones (217,446 entre 1996 y 1998) fue alcanzado en parte por un sistema de cuotas entre funcionarios de Ministerio de Salud, que proporcionada pocos incentivos para el cuidado de calidad de las operaciones.

Secuestrando el feminismo global: feministas, la Iglesia católica y la debacle de la planificación familiar en el Perú / Appropriating of the global feminism: feminists, the catholic church and the fall of the familiar planning in Peru

Entre los años 1996 y 1998 el programa de planificación familiar dirigido por el gobierno de Alberto Fujimori organizó campañas masivas de esterelización dirigidas a mujeres de comunidades pobres, indídigenas y rurales. El programa dio prioridad a la esterelización sobre otras formas de contracepción y realizaró las esterelizaciones quiuen las pacientes. Asimismo, muchas veces realizaron las esterelizaciones sin obtener previamente el consentimiento voluntario o informado de las pacientes. El número estimado de estas esterilizaciones [217,446 entre 1996 y 1998] fue alcanzado en parte por un sistema de cuotas entre funcionarios de Ministerio de Salud, que proporcionada pocos incentivos para el cuidado de calidad de las operaciones. [AU]

O manifesto Eugenista / The eugenisty manifest

Este texto tem como objetivo apresentar o marco inaugural da Eugenia no Brasil. Pesquisas sobre a Eugenia ainda estão restritas a determinadas regiões e os exemplos dos Estados Unidos e da América Latina ainda são freqüentemente negligenciados. Rapidamente associada à Alemanha Nazista, desconhecendo-se a existência mundial das idéias e práticas eugenistas, que ignoraram fronteiras ideológicas e geográficas, a Eugenia surgiu com francis Galton (1822-1911) no final do século XIX e disseminou-se por diversos países. Embora o surgimento dos preceitos eugenistas tenha sido em solo europeu, foi nos Estados Unidos, durante a primeira metade do século XX, que a eugenia assumiu uma das formas mais violentas, modificando drasticamente a vida das pessoas. entre 1907 e 1940, vários estados americanos promoveram cerca de 40.000 esterelizações compulsórias. Somente na Califórnia, mais de 15.000 pessoas teriam sofrido cirurgias deste tipo. Diversas leis foram criadas para esterelizar indivíduos classificados como inadequados e incapazes. em 1904, eram fundados os primeiros laboratórios de aprimoramento racial no mundo (AU)

Patrick C. Steptoe: laparoscopy, sterilization, the test-tube baby, and mass media.

In the late 1950s, Patrick C. Steptoe, a British gynecologist, established contact with Palmer of Paris and Frangenheim of Wuppertal, Germany, and studied laparoscopic technique under the tutelage of these pioneers. Despite the negative attitude among his colleagues, Steptoe soon became one of the most innovative researchers in the field of abdominal endoscopy, particularly laparoscopic sterilization. In the late 1960s, Steptoe began working with Robert Edwards, an embryologist, and launched an in-vitro fertilization project obtaining eggs by means of laparoscopy. Both researchers experienced years of frustration, disappointment, ethical and scientific criticism as well as a difficult relationship with the mass media. Finally, in July 1978, Louise Brown, the first test-tube baby, was born in England. Like many of his colleagues in the 1950s and 1960s, Patrick Christopher Steptoe (1913-1988), a gynecologist in Oldham, Great Britain, was concerned about the number of unnecessary laparotomies. Unfortunately, the Oldham group of hospitals was not a university clinic and Steptoe had scanty opportunity to develop his own research. In the late 1950s, he searched the medical literature for an alternative form of examination and came across publications about Decker's culdoscopy, the vaginal approach to view of the abdomen. Since this method was not widespread in England, Steptoe, in 1958, went to Montreal, Boston, and New York in order to observe and learn the practical use of culdoscopy. However, Steptoe left America disappointed.

[Sterilization of women. A historical review with review of the literature and description of the methods employed in Denmark at present]. / Sterilisation af kvinder. Historisk tilbageblik ved gennemgang af litteraturen-metoder i Danmark i dag.

PIP: Voluntary sterilization was 1st introduced in Singapore and in the state of Virginia in 1969 and since then has spread in popularity across the western world. In 1973, voluntary sterilization was introduced in Denmark. The numbers of sterilizations performed has tripled in Europe and quadrupled in the US. In Denmark, the numbers have risen from approximately 1600 to 7410 annually between 1973-82. The increasing number has resulted in increasing interest in methods which are freer from complications, are rapid, effective, and cosmetically acceptable. Although Osathanondu described a minilaparotomy method in 1973 by which sterilization was carried out via an incision in the skin of 2.5 cm and with an average operating time of 20 minutes, this method is seldom used in Denmark. In 1986, a questionnaire was sent to 79 departments in Denmark which carried out sterilizations on women. 31 departments were specialized gynecological departments and 48 were surgical departments. Of the surgical departments, 24 used laparotomy and 20 laparoscopy while 3 used both and 1 used minilaparotomy. Of the gyncological departments, 27 used laparoscopy, 1 laparotomy, 1 used both, 1 both laparoscopy and minilaparotomy, and 1 used endocoagulation. Since 1978, the laparoscopic sterilizations have increased from 12.5% to 47.9% in surgical departments and from 69.9% to 93.5% in gynecological departments. (author's modified)^ieng

Tubal sterilization. A historical review.

During the 1970s there was a fivefold worldwide increase in the number of sterilizations. Sterilization has emerged in many countries as the most popular method of family planning for couples over 30 years of age. This paper reviews the developments in tubal sterilization, with special emphasis on the early years and the development of laparoscopic techniques.

Tubal sterilization. A prospective long term investigation of 218 sterilized women.

The present study is a long-term investigation of 218 consecutively sterilized women in Akershus County, Norway. The operations were performed in 1973-74, when the access to sterilization was regulated by a legislation from 1934. The women were interviewed personally, and a clinical examination was performed before sterilization, at discharge from hospital, three months, one and six years later. At each occasion the participation was about 95%, and only one woman was lost to follow-up. The women in this series lived in stable social conditions, their average age was 33.7, their parity 2.8. They were not socially distinguishable from women of the same age in the county at large, but there were important socially and age related differences within the series. Their contraceptive usage was widespread, but inconsistent. Family planning was the all-dominant motive. Forty per cent of the women had been suggested the sterilization by a doctor, 30% at abortion application. The operations were performed as laparoscopic electrocoagulation of the tubes or as a Pomeroy resection. Five pregnancies were recognized in the study period, four of these in the laparoscopy group. There were few serious complications, but 20% had a diversity of complaints at the three month interview. At six years seven women had complaints attributed to the operation. The large majority of the series was satisfied with the sterilization. Almost half the women would have preferred an even earlier operation, and six years after the sterilization 85% of the women had told friends about it, and 71% of these had directly recommended sterilization to someone. Six years after the sterilization 74% said the operation should be more widespread, 69% believed postoperative regret was uncommon, and the impact on postoperative marital life was mainly positive. However, during the study period, 18% of the women had experienced regret, ambivalence or periodic depression because of their sterilization. The rate of, and reasons for regret varied with time. The rate increased; at six years 6% of the women would have preferred the sterilization undone, and in 10% of the couples at least one of the partners held that view. At one year, the primary reason for regret was a feeling of having been persuaded by the doctor at abortion application. Six years after the sterilization the desire for a child with a new spouse was the principle reason. There was no association between regret and age or parity at operation.(ABSTRACT TRUNCATED AT 400 WORDS)

The 100th anniversary of tubal sterilization.

PIP: Tubal sterilization is a relatively new operation within gynecology. The history of tubal sterilization since 1809 is traced through old medical texts. Certain details of the procedures being performed to effect tubal sterilization are reviewed. Although laparoscopic tubal sterilization seems to have been tried 1st in 1941, more than 1/4 of a century elapsed before it gained in popularity as a method of sterilization.^ieng